Nationwide Readmission Rates Following Percutaneous Nephrolithotomy: Does Age Matter?
Ashley W. Johnston, MD, Ruiyang Jiang, MD, Muhammad H. Alkazemi, MS, Steven Wolf, MS, Gina-Maria Pomann, PhD, Michael E. Lipkin, MD, Charles D. Scales, MD, Jonathan C. Routh, MD.
Duke University, Durham, NC, USA.
Background: Percutaneous nephrolithotomy (PCNL) remains the gold-standard for stone burden > 2cm and staghorn calculi. Although PCNL has proven to be safe and successful in adult and pediatric patients, there is a lack of literature that directly evaluates age as a comorbidity factor. Our objective was to use a nationally representative database to determine differences in 30-day readmission and complication rates following PCNL between age groups. We hypothesized that the extremes of the age range would have higher complication rates than other age groups.
Methods:
We analyzed the 2013-2014 Nationwide Readmission Databases. We used ICD-9 codes to identify all patients diagnosed with renal stones who underwent PCNL. Patients were divided into 5 age groups: child (<18 years old), young adult (18-25yo), adult (26-64yo), and older adults subdivided into 65-74yo and 75+ yo. Patients with urologic congenital anomalies and those who underwent renal transplantation at the time of PCNL were excluded. December encounters were excluded to impose a 30-day follow-up window. Weighted descriptive statistics were used to describe population demographics. We fit a weighted logistic regression model for 30-day readmission and complication rates.
Results:
We identified 23,357 encounters. The average age was 56 + 0.2 years. Adult patients represented the largest age cohort (62.3%), followed by 65-74yo (21%), 75+ yo (12.1%), young adults (3.4%), and children (1.2%). There was a slightly greater proportion of male than females (55.7% vs. 44.3%). The child group had the highest mean length of stay (11.3 d ± 4.8) and hospitalization costs ($35,361 ± 11,362). The child group had the lowest 30-day readmission rate (7.1%), while the 75+ yo group had the highest rate (18.7%). Similarly, the 75+ yo group had the highest rate of post-operative complications (63.2%). Complication rates were similar for all other age groups. After adjusting for confounders, comparing both child and 75+ yo patients to other age groups, there was insufficient evidence to suggest a difference in 30-day readmissions and post-op complications. However, when comparing 75+ yo encounters to all other age groups, we found that the 75+yo group had increased odds of having a 30-day readmission (OR 4.4, 95%CI 1.4-13.5) and at least one post-op complication (OR 17.3, 95%CI 7.3-40.8) compared to all other age groups.
Conclusions:
Age is an important factor associated with morbidity following PCNL. We did not find evidence to suggest a difference in 30-day readmissions or post-op complications when comparing both <18 yo and >75 yo encounters to other age groups. However, when comparing the 75+yo patients alone against all other age groups, we found that very old patients had increased odds of a 30-day readmission and post-operative complications compared to all other age groups. Physicians should appropriately counsel older adults on their increased risk of postoperative readmission and complications following PCNL.
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